Abstract: Objective To explore the relationship of pretreatment cholinesterase (ChE) and neutrophil-to-lymphocyte (NLR) with the prognosis of patients with metastatic gastric cancer, and establish a nomogram predictive model for those patients. Methods A total of 101 patients who were pathologically diagnosed with metastatic gastric cancer and treated with first-line chemotherapy were enrolled in the current study. The optimal cutoff values of ChE and NLR were calculated by X-tile program. The relationship between ChE, NLR and other clinicopathological characteristics was analyzed. The Kaplan-Meier method was used to analyze the correlation of ChE and NLR with overall survival. Multivariate COX regression was used to analyze the predictors independently associated with the prognosis of metastatic gastric cancer. Furthermore, R software was used to draw a nomogram before internal verification. Results According to multivariate analysis, ChE, NLR, ECOG score and CA-199 were the independent influencing factors of OS in patients with metastatic gastric cancer. These independent factors were adopted to construct the nomogram predictive model. This nomogram had good discrimination and calibration, and the C-index of the model was 0.673. Predictive nomograms and time-independent receiver operating characteristic (ROC) curve that included ChE scores were superior to those without ChE scores. Conclusions Both ChE and NLR are useful in predicting the prognosis of patients with metastatic gastric cancer. The nomogram including ChE shows good consistence and can accurately predict the prognosis of metastatic gastric cancer.